Black Cohosh for Menopause

Black Cohosh is an herb that exerts its effects on the endocrine regulatory (hormonal) mechanism in your body. It's a phytoestrogen, but by definition that means it's weaker than the estrogens your body creates. Structurally, black cohosh more closely resembles estradiol, which researchers believe offers protection against cancer of the endometrium, ovaries and breast.

That's a real conclusion from research done on menopause treatment alternatives. You can take black cohosh for menopausal symptoms and get protection against cancer at the same time.

The most commonly used preparation is black cohosh extract. It is standardized (that's good because you know just how much of the herb you're getting each time you take a capsule) to contain 250 mg of black cohosh extract.

Let's examine the research on how well it works for menopausal symptoms. In a study of 704 women, 49% of the women who took the black cohosh extract experienced complete relief of menopausal symptoms (hot flashes, sweating, headache, vertigo, heart palpitation, and ringing in the ears.) An additional 37.8% reported significant improvement. According to the physicians who participated in the study, 72% of the women who took black cohosh treatment experienced advantages over those given hormonal treatment (as measured by results on the Kupperman Menopausal Index and the Hamilton Anxiety test.)

In another controlled study, of 629 women with menopausal complaints who took a standardized extract of black cohosh twice a day, 76 to 93% had an overall improvement in hot flashes, headache, irritability, heart palpitations, mild depression and sleep disturbances. The reduction in headache, sleep disturbances and heart palpitations is understandable because black cohosh also contains a small amount of salicylic acid (used to make aspirin) that has anti-inflammatory and pain-relieving qualities.

Results of animal studies in Japan suggest that one variety of black cohosh may increase bone mineral density. No human studies have been done yet, but the results point in the direction of black cohosh also helping protect against osteoporosis.

How safe is this herb? More than 45 years' of use in Germany has shown no evidence of serious adverse effects, contraindications or drug interactions. The only side effect shown appeared in only 7% of the participants in one of many studies. In this case, the women experienced a short-term stomach upset, but not enough to stop taking the herb and the problem didn't continue for long.

Another study critically evaluated the safety of black cohosh. The researchers examined all published studies, the FDA and World Health Organization adverse-event reporting systems, monographs, data from major manufacturers, and anecdotal reports. Human trials of more than 2,800 women demonstrated a very low incidence of adverse events (5.4%). Of these, 97% were minor and the only severe events weren't due to taking black cohosh at all.

An important consideration for long-term use of black cohosh, or any substance, is its potential toxicity and cancer-causing attributes. Researchers at Northwestern Medical School found that black cohosh extracts do not demonstrate any estrogenic activity (associated with breast cancer) so in that respect black cohosh is safe. An alarm was sounded in the summer of 2003 in an Australian case report, but the findings were not sufficiently substantiated; also, a case report of one person's reactions does not provide strong evidence while a human trial of thousands of women does.

So far, no overdose amount has been found for black cohosh in humans. In one study involving animals who were given 90 times the daily human equivalent, no negative results were found.

Black cohosh may be a herb you may want to consider taking if you have hot flashes, vaginal pain or itching, depression, or bone loss due to natural or surgically-induced menopause. And don't forget, it also may protect against breast, ovarian and endometrial cancer.

Cautions:

The research shows that for the majority of menopausal women taking black cohosh, it is safe and effective.

Research Study Information: Always look at the population studied in a research report. A case study of one person is very weak evidence, while having a large group who receives the "treatment" and a control group (who doesn't get the "treatment") provides the strongest evidence and can disprove the "novelty" effect of being in a study).

Animal participants provide much weaker correlation with human behavior, especially rats or mice who share little in common with the human species, and test tube results are only good for identifying characteristics of a substance, not for providing evidence about how it might work in humans.

Size of the sample is also important: thousands of women provide much stronger evidence than 4 monkeys or 12 women. Who funded the study is also important: often funding sources may expect specific findings for their product and this can exert a powerful affect on outcomes. (There is always an effect on the results when the researchers collect their own data, but when money is involved, the pull is even stronger.)

Beware of media reports in your newspaper or TV news. The reporter may focus only on what the person who supplied the report suggested. Since reporters are not researchers, they often go along with what is sent to them, or pick out only the most eye-catching information, ignoring the conclusions and recommendations made by the researchers. Always remember that one research study only provides evidence for or against a hypothesis, it never proves or disproves it! The more studies completed that show a strong trend, the more confidence you can have in the results. For the best research information, go to the original study.

Black Cohosh has an effect similar to the female hormone estrogen, which governs the menstrual cycle and declines after menopause. The herb was long used by Native Americans as a remedy for painful menstrual periods. It also has an anti-inflammatory, sedative effect. The medicinal part of the plant is the root, both fresh and dried.

Generations of American women have relied on the gnarled root of black cohosh(Cimicifuga racemosa) to relieve various "female problems," from PMS and menstrual cramps to menopausal symptoms. An American wildflower, a member of the buttercup family, has been recommended as an alternative to standard hormone replacement therapy(HRT), which can produce unwanted side effects in many women.